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By Enyeribe Ejiogu
It was just the work of Providence that Dr Bernice Nneka Njoku (who does want her real name to be used for this story) happened to run into her senior male cousin, Johnson Okwuegbu, at a grocery store in Houston, Texas, where both of them reside with their families.
With a bachelor’s degree in Mass Communication from University of Calabar and Master’s in Public Relations from University of Lagos, Njoku relocated to Houston in 2000 to join her husband, a pharmacist, who had won the United States visa lottery two years earlier and settled down, working as a pharmaceutical research scientist in a subsidiary of Pfizer.
Like a number of other female Nigerians in the United States, Njoku saw opportunity in healthcare services as there was a demand for nurses. Having passed Biology and Chemistry with credits in WAEC, she studied for nursing school exams. She passed the entrance exam and trained as a nurse. Later she passed the American certification exams for nurses and was employed by a popular hospital which is part of a national chain of health facilities owned by a hospital corporation. After working for over eight years and earning additional qualifications and certifications, she enrolled for a doctorate degree programme in Emergency Medicine and Trauma Care Nursing which she completed successfully. Shortly after, a door opened for her to relocate to Canada to work on a special consultancy project funded by the Canadian government.
On the fateful day in 2010, as she exchanged pleasantries with Johnson, she noticed something odd about the face of her cousin. His mouth seemed to be twisting towards one side and his speech slightly slurred. Alarmed, she quickly recognised the early signs of stroke. Njoku fished out her cellphone and immediately called 911. When a dispatcher responded, she introduced herself and profession, told her the situation and requested for an ambulance to be sent to her location. Within five minutes, a nearby paramedical team arrived at the grocery store. Her cousin, a good-natured but somewhat stubborn fellow was quickly rushed to the hospital and trauma care processes were initiated. The result was that a full blown, possibly fatal stroke was prevented from happening. “If my brother had tried to drive away from that grocery store he would have probably had the stroke on the way, had an accident and nobody would even suspect it was a stroke that caused it. When I look at him today, when he is being a little bit stubborn in his usual manner, I brush it off. I just love him. I would rather have him alive and stubborn than dead and gone.”
It needs to be stated clearly that a stroke is a medical emergency. It happens when a blood vessel in the brain bursts or, more commonly, when a blockage happens. Without treatment, cells in the brain quickly begin to die. This can cause serious disability or death. If a loved one is having stroke symptoms, please rush the person to the nearest hospital immediately.
Stroke symptoms
The signs of stroke may include the following sudden manifestations:
Numbness or weakness of the body, especially on one side
Vision changes in one or both eyes, or trouble swallowing
Severe headache with an unknown cause
Problems with dizziness, walking, or balance
Confusion, trouble speaking or understanding others
Think FAST
The FAST test helps spot symptoms. It stands for:
Face drooping. Ask for a smile. Does one side droop?
Arm weakness or numbness.
Speech. Can the person repeat a simple sentence? Do they have trouble or slur words?
Time to rush off to hospital. Don’t delay.
Time = Brain Damage
Every second counts. Without oxygen, brain cells begin dying within minutes. Once brain tissue has died, the body parts controlled by that area won’t work right. This makes stroke a top cause of long-term disability. There are clot-busting drugs that can curb brain damage, and they must be given in a short time – usually within 3 hours of when symptoms start.
Diagnosis
Tests may start when you’re still in the ambulance. Once you get to the A & E Unit (accident and emergency room) or ER (emergency room as it is known in some countries) you’ll get imaging tests such as a CT scan, MRI, or ultrasound. You may get other types of tests, such as an EKG (which checks the heart’s electrical activity) and an EEG (to check the brain’s electrical activity).
Ischemic stroke
This is the most common type of stroke: Nearly nine out of 10 cases fall into this category. An ischemic stroke happens when a blood clot blocks the supply of blood to or in the brain. The clot may start in that spot or travel through the blood from elsewhere in the body. Clogged arteries are a top cause.
Haemorrhagic stroke
Haemorrhagic strokes happen when a weakened blood vessel in the brain bursts. The result is bleeding inside the brain that can be hard to stop. The most common cause is high blood pressure. Other causes include aneurysms and AVMs (arteriovenous malformations), which weaken blood vessels in the brain.
‘Mini-stroke’ (TIA)
Transient ischemic attacks, often called “mini-strokes” are also an emergency. When they happen, blood flow is temporarily hampered in part of the brain, causing stroke-like symptoms. When the blood flows again, the symptoms stop. You cannot tell at the time if it’s a stroke or TIA. So the person rush off to the hospital. Having a TIA is also a warning sign, so see your doctor if you think you’ve had one.
Emergency treatment
Ischemic strokes: The goal is to restore blood flow. A clot-busting medication called tPA is very good at dissolving clots and cutting the chance of long-term damage, but it must be given in time, usually within three hours.
Haemorrhagic strokes: These are harder to manage. Treatment usually involves trying to control high blood pressure, bleeding, and brain swelling.
Causes of stroke
Ischemic strokes: Clogged arteries are a top cause. Plaque (made of fat, cholesterol and other things) builds up in the arteries, leaving less space for blood to flow. A blood clot may lodge in this narrowed space and cause an ischemic stroke. All that plaque makes it easier for a clot to form and can also rupture, blocking blood flow.
Haemorrhagic strokes: These can happen if uncontrolled high blood pressure bursts a weakened artery.
Risk factors
Your chance of having a stroke rises with age and if you have:
Had a stroke or TIA before
Heart disease
High blood pressure
High cholesterol
Diabetes
Obesity
Sickle cell disease
Smoking, heavy drinking, and not being active also raise your risk.
What’s on your plate?
Eating too much fat and cholesterol can cause plaque to narrow arteries. Too much salt may lead to high blood pressure. Eating plenty of fruits, vegetables, whole grains, and fish may help lower your stroke risk.
Lowering your risk
Find out if you have any conditions that you need to treat to help prevent a stroke. That may mean taking medicine and also boosting healthy habits, from the foods you eat to being active and not smoking. It’s never too late to start.
